肠内营养制剂在急性淋巴细胞白血病患儿诱导治疗期的营养支持作用及对化疗并发症的影响  

Enteral nutrition support for children with acute lymphoblastic leukemia in the stage of induction chemotherapy and effect on chemotherapy complications

作　　者：王超 栗达[2] 林巍 张元元 范佳 于娇乐 张瑞东 吴颖 漆佩静 陆继冉 李静 林嘉衍 郑雪岭 闫洁[2] 郑胡镛 Wang Chao;Li Da;Lin Wei;Zhang Yuanyuan;Fan Jia;Yu Jiaole;Zhang Ruidong;Wu Ying;Qi Peijing;Lu Jiran;Li Jing;Lin Jiayan;Zheng Xueling;Yan Jie;Zheng Huyong(Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China;Department of Nutrition, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院血液肿瘤中心,儿童血液病与肿瘤分子分型北京市重点实验室,儿科学国家重点学科,儿科重大疾病研究教育部重点实验室,北京100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院营养科,北京100045

出　　处：《中华实用儿科临床杂志》2019年第17期1335-1339,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家科技重大专项(2017ZX09304029004);北京市医院管理局临床医学发展专项(ZY201404);北京市医院管理局登峰计划(DFL20151101);首都卫生发展科研专项-重点攻关(首发2016-I-2091).

摘　　要：目的通过在儿童急性淋巴细胞白血病(ALL)患儿诱导治疗期给予肠内营养支持,观察该段时间内患儿营养学指标的变化及对化疗并发症的影响,并观察肠内营养制剂的安全性。方法选择2016年11月至2017年9月在北京儿童医院血液肿瘤中心的60例初诊ALL患儿为研究对象,采用简单随机化方法平行分为试验组和对照组,每组各30例。试验组在常规低脂饮食的基础上,给予高热卡、优质蛋白、高中链三酰甘油型肠内营养制剂,持续时间为ALL患儿诱导治疗期间,对照组则按常规给予低脂饮食。通过分析诱导化疗前(D0)、化疗第15天(D15)及化疗第33天(D33)的相关指标,了解2组患儿营养状态变化及对化疗并发症的影响。结果2组患儿体质量指数(BMI)及肱三头肌皮褶厚度在化疗前后无明显变化,差异均无统计学意义(均P>0.05),但试验组化疗后上臂围上升[治疗前:(15.80±2.63) cm,治疗后(16.27±2.57) cm],对照组较化疗前下降[化疗前:(17.19±3.71) cm,化疗后:(17.15±3.64) cm],差异均有统计学意义(均P<0.05)。化疗后2组总蛋白[试验组:(64.52±4.85) g/L,对照组:(61.97±4.65) g/L]均下降,与化疗前[试验组:(68.17±6.37) g/L,对照组:(68.08±5.14) g/L]比较差异均有统计学意义(均P<0.01);试验组化疗后总蛋白水平高于对照组,下降幅度较小,差异有统计学意义(P<0.05)。化疗后2组清蛋白[试验组:(42.45±4.32) g/L,对照组:(41.15±3.73) g/L]均上升,与化疗前[试验组:(39.54±3.26) g/L,对照组:(40.01±4.37) g/L]比较差异均有统计学意义(均P<0.05)。2组化疗后前清蛋白水平[试验组:(324.57±64.328) mg/L,对照组(293.07±69.09) mg/L]均上升,与化疗前比较差异均有统计学意义(均P<0.05);试验组化疗前前清蛋白水平低于对照组,化疗后反而高于对照组,2组前清蛋白比较差异均有统计学意义(均P<0.05)。试验组化疗后元素铁减低率低于对照组,但差异无统计学意义(P>0.05)。元素锌与�Objective To observe the changes in nutrition indicators and the effect on chemotherapy complications as well as the safety of enteral nutrition by way of providing enteral nutrition support for children with acute lymphoblastic leukemia (ALL) at the stage of induction chemotherapy. Methods From November 2016 to September 2017, 60 children with newly diagnosed ALL at the Hematology Oncology Center of Beijing Children′s Hospital were enrolled in this study.They were randomly divided into an experimental group and a control group, 30 cases for each group.The experimental group was given a high-calorie diet, high-quality protein, and high-medium-chain trigly-ceride enteral nutrition on the basis of a conventional low-fat diet, and the duration lasted the whole induction treatment of ALL children;while the control group was given a low-fat diet routinely.By analyzing relevant indicators before induction chemotherapy (D0), chemotherapy day 15 (D15), and after chemotherapy (D33), the changes in nutritional status and the effect on chemotherapy complications in 2 groups were investigated. Results There was no significant difference in the body mass index (BMI) and the thickness of triceps skinfold between 2 groups before and after chemotherapy (all P>0.05). The upper arm circumference increased after chemotherapy in the experimental group[before treatment:(15.80±2.63) cm, after treatment:(16.27±2.57) cm], while that of the control group decreased slightly[before chemotherapy:(17.19±3.71) cm, after chemotherapy:(17.15±3.64) cm], and the difference between 2 groups was statistically significant (P<0.05). After chemotherapy, the total protein levels in two groups decreased[the experimental group:(64.52±4.85) g/L, the control group:(61.97±4.65) g/L] which was significantly different from that before chemotherapy [the experimental group:(68.17±6.37) g/L, the control group:(68.08±5.14) g/L](P<0.01). The total protein level of the experimental group after chemotherapy was significant higher than that in the control g

关 键 词：淋巴细胞白血病 急性 儿童 肠内营养支持 化疗并发症 

分 类 号：R733.71[医药卫生—肿瘤]